ALS, Amyotrophic lateral sclerosis

ALS,肌萎缩侧索硬化
  • 文章类型: Journal Article
    医学中一些最大的挑战是神经退行性疾病(ND),仍然没有治愈,大部分进展到死亡。一项伴随研究采用了一种工具包方法来记录2001年具有种族医学用途的植物物种,以减轻与ND相关的病理,重点关注其与阿尔茨海默病(AD)的相关性。这项研究旨在寻找对一系列ND具有治疗性生物活性的植物。2001年植物物种中的1339种被发现具有治疗相关的生物活性,如帕金森病,亨廷顿病,AD,运动神经元疾病,多发性硬化症,朊病毒病,Neimann-Pick病,青光眼,弗里德赖希的共济失调和巴滕病。发现了43种生物活性,比如减少蛋白质的错误折叠,神经炎症,氧化应激和细胞死亡,促进神经发生,线粒体生物发生,自噬,长寿,和抗微生物活性。Ethno主导的植物选择比植物物种的随机选择更有效。我们的发现表明,食草植物提供了大量ND治疗潜力的资源。广泛的生物活性验证了工具包方法在挖掘此数据中的有用性。我们发现,许多有文献记载的植物能够调节各种关键ND病理的分子机制,揭示了一种有希望甚至深刻的能力来阻止和逆转神经变性的过程。
    Some of the greatest challenges in medicine are the neurodegenerative diseases (NDs), which remain without a cure and mostly progress to death. A companion study employed a toolkit methodology to document 2001 plant species with ethnomedicinal uses for alleviating pathologies relevant to NDs, focusing on its relevance to Alzheimer\'s disease (AD). This study aimed to find plants with therapeutic bioactivities for a range of NDs. 1339 of the 2001 plant species were found to have a bioactivity from the literature of therapeutic relevance to NDs such as Parkinson\'s disease, Huntington\'s disease, AD, motor neurone diseases, multiple sclerosis, prion diseases, Neimann-Pick disease, glaucoma, Friedreich\'s ataxia and Batten disease. 43 types of bioactivities were found, such as reducing protein misfolding, neuroinflammation, oxidative stress and cell death, and promoting neurogenesis, mitochondrial biogenesis, autophagy, longevity, and anti-microbial activity. Ethno-led plant selection was more effective than random selection of plant species. Our findings indicate that ethnomedicinal plants provide a large resource of ND therapeutic potential. The extensive range of bioactivities validate the usefulness of the toolkit methodology in the mining of this data. We found that a number of the documented plants are able to modulate molecular mechanisms underlying various key ND pathologies, revealing a promising and even profound capacity to halt and reverse the processes of neurodegeneration.
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  • 文章类型: Case Reports
    UNASSIGNED:肌萎缩侧索硬化症是一种神经退行性疾病,与之相关的遗传差异很大。在描述的不同基因中,在肌萎缩侧索硬化症中,TFG突变是一种罕见的发现。
    未经证实:一名35岁的右撇子男性表现为同侧无力,被诊断为肌萎缩侧索硬化症。发现他具有TFG的错义变体,对外显子组测序具有不确定的意义。
    未经证实:与肌萎缩侧索硬化症有关的遗传学是不断发展的。在该疾病中新的TFG变体的鉴定增加了TFG在神经退行性疾病中的作用的另一个证据。
    UNASSIGNED:在肌萎缩侧索硬化症中发现具有不确定意义的TFG变异体是一个罕见的发现。随着新TFG变体的鉴定,这有助于进一步了解肌萎缩侧索硬化症的TFG谱及其病理生理学。
    UNASSIGNED: Amyotrophic lateral sclerosis is a neurodegenerative disease with wide variation of genetics associated with it. Among the different genes described, mutation in TFG is a rare finding in amyotrophic lateral sclerosis.
    UNASSIGNED: A 35 years old right-handed male presenting with ipsilateral weakness was diagnosed with amyotrophic lateral sclerosis. He was found to have missense variant of TFG with uncertain significance on exome sequencing.
    UNASSIGNED: The genetics involved in amyotrophic lateral sclerosis is ever-evolving. The identification of new TFG variant in this disease adds another evidence to the role of TFG in neurodegenerative disease.
    UNASSIGNED: The finding of TFG variant of uncertain significance is a rare finding in amyotrophic lateral sclerosis. And with the identification of new TFG variant, it leads to further understanding of spectrum of TFG and its pathophysiology in amyotrophic lateral sclerosis.
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  • 文章类型: Journal Article
    自1990年代以来,退伍军人健康管理局(VHA)维护了一个退伍军人脊髓损伤和疾病(SCI/Ds)的登记册,以指导临床护理。政策,和研究。历史上,为VHASCI/D注册(VSR)收集和记录数据的方法需要大量时间,成本,和人员配备,容易丢失数据,并导致汇总和报告延迟。在过去的几十年中,随后的每种数据收集方法都旨在改善这些问题。本文介绍了使用主要临床数据的病例发现和数据捕获算法的开发和验证,包括900万份VHA电子病历的诊断和利用,创建自2012年以来在SCI/D服务中看到的在世和已故退伍军人的全面注册表。使用多步骤过程来开发和验证计算机算法,以创建具有SCI/D的退伍军人的全面注册表,其记录保存在企业范围的VHACorporateDataWarehouse中。图表审查和有效性检查用于验证使用新算法识别的案例的准确性。对从2012年10月1日至2017年9月30日参加VHA护理的28,202名SCI/D在世和已故退伍军人的初始队列进行了验证。表格,reports,并开发了使用VSR数据的图表,以提供研究的操作工具,预测,并改善对SCI/Ds退伍军人的针对性管理和护理。现代化的VSR包括诊断数据,合格的会计年度,最近的利用,人口统计,损伤,截至2022年11月2日,38022名退伍军人的减值。这将VSR确立为北美最大的正在进行的纵向SCI/D数据集之一,并为VHA人群健康管理和循证康复提供运营报告。VSR还包括非创伤性SCI/Ds患者的唯一注册中心之一,并具有推进多发性硬化症(MS)研究和治疗的潜力。肌萎缩侧索硬化(ALS),和其他脊髓受累的运动神经元疾病。VSR数据的选定趋势表明,SCI/Ds退伍军人未来的终身护理需求可能存在差异。使用VSR的未来合作研究为SCI/Ds患者提供了知识和改善医疗保健的机会。
    Since the 1990s, Veterans Health Administration (VHA) has maintained a registry of Veterans with Spinal Cord Injuries and Disorders (SCI/Ds) to guide clinical care, policy, and research. Historically, methods for collecting and recording data for the VHA SCI/D Registry (VSR) have required significant time, cost, and staffing to maintain, were susceptible to missing data, and caused delays in aggregation and reporting. Each subsequent data collection method was aimed at improving these issues over the last several decades. This paper describes the development and validation of a case-finding and data-capture algorithm that uses primary clinical data, including diagnoses and utilization across 9 million VHA electronic medical records, to create a comprehensive registry of living and deceased Veterans seen for SCI/D services since 2012. A multi-step process was used to develop and validate a computer algorithm to create a comprehensive registry of Veterans with SCI/D whose records are maintained in the enterprise wide VHA Corporate Data Warehouse. Chart reviews and validity checks were used to validate the accuracy of cases that were identified using the new algorithm. An initial cohort of 28,202 living and deceased Veterans with SCI/D who were enrolled in VHA care from 10/1/2012 through 9/30/2017 was validated. Tables, reports, and charts using VSR data were developed to provide operational tools to study, predict, and improve targeted management and care for Veterans with SCI/Ds. The modernized VSR includes data on diagnoses, qualifying fiscal year, recent utilization, demographics, injury, and impairment for 38,022 Veterans as of 11/2/2022. This establishes the VSR as one of the largest ongoing longitudinal SCI/D datasets in North America and provides operational reports for VHA population health management and evidence-based rehabilitation. The VSR also comprises one of the only registries for individuals with non-traumatic SCI/Ds and holds potential to advance research and treatment for multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), and other motor neuron disorders with spinal cord involvement. Selected trends in VSR data indicate possible differences in the future lifelong care needs of Veterans with SCI/Ds. Future collaborative research using the VSR offers opportunities to contribute to knowledge and improve health care for people living with SCI/Ds.
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  • 文章类型: Journal Article
    未经证实:使用经颅磁刺激(TMS)来描绘两种神经退行性疾病的上运动神经元(UMN)体征:肌萎缩侧索硬化症(ALS)和多系统萎缩(MSA)。
    UNASSIGNED:对包括UMN损伤的临床体征和TMS结果在内的医疗记录进行回顾性分析。UMN标志被归类为无,温和,根据各种反射的神经系统检查,严重。然后从手部和腿部肌肉记录TMS引起的运动诱发电位(MEP),以计算中枢运动传导时间(CMCT)。这代表了快速,沿着皮质脊髓束的单突触传导。分析了两种疾病的UMN体征与CMCT之间的关系。
    UNASSIGNED:上肢和下肢ALS和MSA的UMN体征的患病率和严重程度相当。然而,CMCT的异常在ALS中更常见:在ALS患者中,上肢有44%的CMCT异常,但在MSA患者中只有7%的CMCT异常;下肢CMCT异常在ALS中占55%,在MSA中占20%.部分ALS患者四肢CMCT异常,无UMN征象,这对大多数MSA患者来说是不正确的。
    未经证实:在ALS和MSA中,CMCT的异常是不同的,即使对于那些临床上有类似的UMN症状的人。有时候,CMCT可以在没有临床UMN体征的情况下揭示UMN损伤。差异可能源于运动下降途径中不同纤维的选择性变性。必须进行纵向研究以积累神经影像学和病理学发现。
    UNASSIGNED:CMCT可用于区分ALS和MSA。
    UNASSIGNED: Using transcranial magnetic stimulation (TMS) to delineate upper motor neuron (UMN) signs of two neurodegenerative disorders: amyotrophic lateral sclerosis (ALS) and multiple system atrophy (MSA).
    UNASSIGNED: Medical records including clinical signs for UMN damage and TMS results were reviewed retrospectively. The UMN signs were classified into none, mild, and severe based on neurological examination of various reflexes. Then TMS-elicited motor evoked potentials (MEPs) were recorded from a hand and a leg muscle to calculate the central motor conduction time (CMCT), which represents fast, mono-synaptic conduction along the corticospinal tract. Relations between the UMN signs and CMCT were analysed for the two diseases.
    UNASSIGNED: Prevalence and severity of the UMN signs for ALS and MSA were comparable for both upper and lower limbs. However, abnormality in CMCT was found more frequently in ALS: CMCT abnormalities were found in upper limbs for 44% in ALS patients but only for 7% in MSA patients; CMCT abnormalities in lower limbs were 55% in ALS and 20% in MSA. Some ALS patients showed abnormal CMCT in limbs without UMN signs, which was not true for most MSA patients.
    UNASSIGNED: The abnormalities of CMCT were different in ALS and MSA, even for those who clinically had similar UMN signs. Sometimes, CMCT can reveal UMN damage in the absence of clinical UMN signs. Differences presumably derive from selective degeneration of different fibres in the motor descending pathways. Longitudinal studies must be conducted to accumulate neuroimaging and pathological findings.
    UNASSIGNED: CMCT can be useful to differentiate ALS and MSA.
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  • 文章类型: Journal Article
    端粒长度(TL)是生物衰老的生物标志物。较短的端粒与死亡率和年龄相关疾病的发病率增加有关。然而,观察性研究无法得出TL是否与这些结局有因果关系的结论.孟德尔随机化(MR)是在流行病学研究中使用遗传变异来评估因果关系的。这项研究的目的是通过MR分析来测试TL在神经退行性疾病和预期寿命中的潜在因果作用。摘要水平数据是从最新的全基因组关联研究中提取的,阿尔茨海默病(AD),帕金森病,额颞叶痴呆,肌萎缩侧索硬化症,进行性核上性麻痹和预期寿命。MR估计显示,较长的端粒推断对AD风险的保护作用(OR=0.964;调整后的p值=0.039)。此外,端粒延长与预期寿命增加显著相关(βIVW=0.011;调整后p值=0.039).敏感性分析提供了AD分析中方向性多效性的证据。我们的结果表明,遗传预测的较长的TL可能会增加预期寿命并对AD发挥保护性因果作用。我们没有观察到较长的TL和其他神经退行性疾病之间的显著因果关系。这表明TL对特定生物学机制的参与可能在AD和预期寿命之间有所不同。关于其他神经退行性疾病。此外,多效性的存在可能反映了TL稳态和AD病理生理学之间复杂的相互作用。需要进一步的观察研究来证实这些结果。
    Telomere length (TL) is a biomarker of biological aging. Shorter telomeres have been associated with mortality and increased rates of age-related diseases. However, observational studies are unable to conclude whether TL is causally associated with those outcomes. Mendelian randomization (MR) was developed for assessing causality using genetic variants in epidemiological research. The objective of this study was to test the potential causal role of TL in neurodegenerative disorders and life expectancy through MR analysis. Summary level data were extracted from the most recent genome-wide association studies for TL, Alzheimer\'s disease (AD), Parkinson\'s disease, Frontotemporal dementia, Amyotrophic Lateral Sclerosis, Progressive Supranuclear Palsy and life expectancy. MR estimates revealed that longer telomeres inferred a protective effect on risk of AD (OR = 0.964; adjusted p-value = 0.039). Moreover, longer telomeres were significantly associated with increased life expectancy (βIVW  = 0.011; adjusted p-value = 0.039). Sensitivity analyses suggested evidence for directional pleiotropy in AD analyses. Our results showed that genetically predicted longer TL may increase life expectancy and play a protective causal effect on AD. We did not observe significant causal relationships between longer TL and other neurodegenerative diseases. This suggests that the involvement of TL on specific biological mechanisms might differ between AD and life expectancy, with respect to that in other neurodegenerative diseases. Moreover, the presence of pleiotropy may reflect the complex interplay between TL homeostasis and AD pathophysiology. Further observational studies are needed to confirm these results.
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  • 文章类型: Case Reports
    当咳嗽能力受损时,可以通过机械吹入-吹出(MI-E)处理来辅助和增强分泌清除。在患有肌萎缩侧索硬化症的患者中,MI-E的疗效可能受到上气道反应的阻碍.仔细调整MI-E设置可能是有益的。在疾病进展过程中,一名41岁的延髓肌萎缩侧索硬化症患者经历了MI-E治疗的疲惫和低效。尽管调整了设置,所有的治疗都导致干咳。MI-E装置的改变导致更有效的治疗。台架测试表明,两个设备中的流量和压力波形发生变化。当MI-E治疗失败时,除了调整MI-E设置外,还需要考虑设备交付的差异。
    When the ability to cough is impaired, secretion clearance may be assisted and augmented by Mechanical Insufflation-Exsufflation (MI-E) treatment. In patients with Amyotrophic Lateral Sclerosis, the efficacy of MI-E may be hampered by counterproductive upper airway responses. Careful adjustment of MI-E settings can be beneficial. During the disease progression, a 41-year-old woman with bulbar Amyotrophic Lateral Sclerosis experienced that treatment with MI-E was exhausting and inefficient. Despite adjustments of settings, all treatment led to retching. A change of MI-E device led to more effective treatment. A bench test revealed variations in flow and pressure waveforms in the two devices. When MI-E treatment fails, differences in equipment delivery need to be considered in addition to the adjustment of MI-E settings.
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  • 文章类型: Journal Article
    目的:部分容积效应(PVE)使神经退行性疾病的PET研究复杂化,因为18F-FDG滞留减少可能受皮质区域萎缩相关变化的影响。因此,已经开发了多种部分体积校正(PVC)方法,但它们在肌萎缩侧索硬化症(ALS)中的应用仍然很少。此外,即使在ALS中已经确定了代谢变化,尚未有研究调查这些可能受到衰老和病程的影响。因此,本研究的目的是应用和比较多种PVC方法来探索ALS中与衰老和病程相关的低代谢。
    方法:使用PETSurfer对15例ALS患者的PET和MRI数据进行了分析,以实施4种不同的PVC方法:noPVC,Meltzer(MZ),Müller-Gärtner(MG)和对称几何传递矩阵(SGTM)。对于每种方法和感兴趣区域(ROI),18F-FDG值根据受试者年龄和疾病持续时间进行回归.
    结果:MG/SGTM的应用几乎使显示出与年龄有关的显着低代谢的区域数量减半,虽然在病程中未观察到相同的效果,其中只有已识别区域的分布有所不同。出现了三种不同的模式:在所有不同方法中显示出与年龄/病程相关的显着影响的区域,仅在MG/SGTM应用时产生意义的区域,和区域仅在NOPVC/MZ应用中保持重要性。
    结论:当考虑到潜在结构状态的影响时,观察到衰老和病程相关的低代谢的分布发生了显着变化,支持在临床和研究环境中研究PVE对PET评估的代谢变化的影响。
    OBJECTIVE: The partial volume effect (PVE) complicates PET studies of neurodegenerative diseases, since a decreased 18F-FDG retention might be influenced by atrophy-related changes of cortical regions. Multiple partial volume correction (PVC) methods have been therefore developed, but their application in amyotrophic lateral sclerosis (ALS) is still rare. Additionally, even if metabolic changes have been established in ALS, no study yet has investigated how these may be influenced by aging and disease course. The aim of the present study was therefore to apply and compare multiple PVC approaches to explore aging and disease course-related hypometabolism in ALS.
    METHODS: PET and MRI data from 15 ALS patients were analyzed using PETSurfer to implement 4 distinct PVC methods: noPVC, Meltzer (MZ), Müller-Gärtner (MG) and Symmetric Geometric Transfer Matrix (SGTM). For each method and Region of Interest (ROI), the 18F-FDG value was regressed against subject age and disease duration.
    RESULTS: MG/SGTM application almost halved the number of regions showing a significant age-related hypometabolism, while the same effect was not observed for disease course, where only the distribution of identified regions varied. Three distinct patterns emerged: regions showing a significant age/disease course-related effect across all the different methods, regions yielding significance only with MG/SGTM application, and regions maintaining significance only with noPVC/MZ application.
    CONCLUSIONS: Significant changes in the distribution of aging and disease course-related hypometabolism were observed when the effect of the underlying structural status was considered, supporting the need for investigate the impact of PVE on PET-assessed metabolic changes in clinical and research settings.
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  • 文章类型: Journal Article
    肌萎缩侧索硬化症(ALS)是一种致命的疾病,进行性性质的特征是失去上运动神经元和下运动神经元的功能。主要挑战之一是了解ALS多因素性质的机制。我们旨在通过生物信息学方法探索与ALS相关的一些关键基因,以进行治疗干预。这里,我们应用了一种系统生物学方法,该方法涉及通过实验验证的148种ALS相关蛋白,并构建了ALS蛋白-蛋白相互作用网络(ALS-PPIN).对该网络进行了进一步的统计分析,并确定了瓶颈中心。网络还受到可以具有类似功能的识别模块的影响。模块和瓶颈中心之间的相互作用提供了ALS机制的功能调节作用。ALS-PPIN表现出分层无标度性质。我们确定了17个瓶颈中心,其中CDC5L,SNW1,TP53,SOD1和VCP是ALS-PPIN的高度节点(集线器)。发现CDC5L控制高度集群模块,并在整个网络的稳定性中起着至关重要的作用,其次是SNW1,TP53,SOD1和VCP。HSPA5和HSPA8充当CDC5L和TP53瓶颈集线器的通用连接器。功能和疾病关联分析显示ALS与mRNA加工有很强的相关性,蛋白质去泛素化,和肿瘤,神经系统,免疫系统疾病类别。在未来,对观察到的瓶颈中心及其相互作用伙伴的生化研究可以进一步了解它们在ALS病理生理学中的作用.
    Amyotrophic Lateral Sclerosis (ALS) is a fatal disease, progressive nature characterizes by loss of both upper and lower motor neuron functions. One of the major challenge is to understand the mechanism of ALS multifactorial nature. We aimed to explore some key genes related to ALS through bioinformatics methods for its therapeutic intervention. Here, we applied a systems biology approach involving experimentally validated 148 ALS-associated proteins and construct ALS protein-protein interaction network (ALS-PPIN). The network was further statistically analysed and identified bottleneck-hubs. The network is also subjected to identify modules which could have similar functions. The interaction between the modules and bottleneck-hubs provides the functional regulatory role of the ALS mechanism. The ALS-PPIN demonstrated a hierarchical scale-free nature. We identified 17 bottleneck-hubs, in which CDC5L, SNW1, TP53, SOD1, and VCP were the high degree nodes (hubs) in ALS-PPIN. CDC5L was found to control highly cluster modules and play a vital role in the stability of the overall network followed by SNW1, TP53, SOD1, and VCP. HSPA5 and HSPA8 acting as a common connector for CDC5L and TP53 bottleneck-hubs. The functional and disease association analysis showed ALS has a strong correlation with mRNA processing, protein deubiquitination, and neoplasms, nervous system, immune system disease classes. In the future, biochemical investigation of the observed bottleneck-hubs and their interacting partners could provide a further understanding of their role in the pathophysiology of ALS.
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  • 文章类型: Journal Article
    反式反应DNA结合蛋白43kDa(TDP-43)是一种在人体组织中高度保守且广泛表达的蛋白,其调节核酸加工。额颞叶痴呆和肌萎缩侧索硬化症,然而,TDP-43在中枢神经组织中形成不溶性聚集体。TDP-43的这些病理沉积主要通过配体结合进行研究,即蛋白质印迹分析,and,因此,需要具有更大结构分辨率的方法来帮助我们理解与TDP-43错误折叠和聚集相关的病理过程.为了这个目标,我们开发了一种使用液相色谱串联质谱法检测和表征TDP-43的选择性和多重方法。作为概念证明,该方法用于人细胞系和人脑组织中TDP-43的检测和表征。
    Transactive response DNA-binding protein 43 kDa (TDP-43) is a highly conserved and widely expressed protein in human tissues that regulates nucleic acid processing. In frontotemporal dementia and amyotrophic lateral sclerosis, however, TDP-43 forms insoluble aggregates in central nervous tissues. These pathological deposits of TDP-43 have been primarily studied by ligand binding, namely western blot analysis, and, thus, methods with greater structural resolution are needed to aid in our understanding of the pathological processes associated with TDP-43 misfolding and aggregation. Toward this goal, we have developed a selective and multiplex method for the detection and characterization of TDP-43 using liquid chromatography tandem mass spectrometry. As proof-of-concept, the method was applied to the detection and characterization of TDP-43 in human cell lines and human brain tissue.
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  • 文章类型: Journal Article
    少数桥本氏甲状腺炎或Graves病患者发展为中枢神经系统(CNS)的多种形式综合征,称为桥本氏脑病或与自身免疫性甲状腺疾病相关的类固醇反应性脑病(HE/SREAT)。他们有高水平的甲状腺自身抗体(TgAb,TPOAb和/或TSH-R-Ab)在血液和脑脊液中。抗α-烯醇化酶的自身抗体,醛还原酶-I(AKRIA)和/或二甲基精氨酸酶-I(DDAHI),在中枢神经系统其他组织中表达的蛋白质,在血液中检测到,搜索时,在HE/SREAT患者的脑脊液中。最近,我们报道了α-烯醇化酶,AKRIA和DDAHI与三种自身抗原(TgAb,TPOAb,TSH-R-Ab),通常在甲状腺自身抗原的含表位片段中。我们假设可能存在与甲状腺自身抗原同源的其他CNS表达蛋白,可能与甲状腺自身抗原的已知表位重叠。我们使用生物信息学方法来解决这一假设。六,46,809个CNS表达的蛋白质中的27和47个与TSH-R具有同源性,Tg和TPO,分别。同源区通常含有表位,和一些与α-烯醇化酶同源的甲状腺自身抗原的匹配区域,AKRIA和/或DDAHI。在HE/SREAT患者中显示神经成像异常的CNS区域中存在几种上述蛋白质。此外,针对上述六种中的一些的自身抗体,据报道,27和47种蛋白质与许多自身免疫性疾病相关。我们不仅验证了我们的假设,但我们认为,针对与CNS蛋白具有局部同源性的区域中所含表位的甲状腺Ab的各种潜在CNS靶标可能解释了HE/SREAT的多态性表型.只有当大量的这些Ab被合成并侵入血脑屏障时,出现HE/SREAT。这也许可以解释为什么他/SREAT是如此相对罕见。
    A few patients with Hashimoto\'s thyroiditis or Graves\' disease develop a multiform syndrome of the central nervous system (CNS) termed Hashimoto\'s encephalopathy or steroid-responsive encephalopathy associated with autoimmune thyroid disease (HE/SREAT). They have high levels of thyroid autoantibodies (TgAb, TPOAb and/or TSH-R-Ab) in blood and cerebrospinal fluid. Autoantibodies against alpha-enolase, aldehyde reductase-I (AKRIA) and/or dimethylargininase-I (DDAHI), proteins expressed in the CNS among other tissues, were detected in the blood and, when searched, in the cerebrospinal fluid of HE/SREAT patients. Recently, we reported that alpha-enolase, AKRIA and DDAHI share local sequence homology with each of the three autoantigens (TgAb, TPOAb, TSH-R-Ab), often in epitope-containing segments of the thyroid autoantigens. We hypothesized that there might be additional CNS-expressed proteins homologous to thyroid autoantigens, possibly overlapping known epitopes of the thyroid autoantigens. We used bioinformatic methods to address this hypothesis. Six, 27 and 47 of 46,809 CNS-expressed proteins share homology with TSH-R, Tg and TPO, respectively. The homologous regions often contain epitopes, and some match regions of thyroid autoantigens which have homology with alpha-enolase, AKRIA and/or DDAHI. Several of the aforementioned proteins are present in CNS areas that show abnormalities at neuroimaging in HE/SREAT patients. Furthermore, autoantibodies against some of the said six, 27 and 47 proteins were reported to be associated with a number of autoimmune diseases. Not only we validated our hypothesis, but we think that such a variety of potential CNS targets for thyroid Ab against epitopes contained in regions that have local homology with CNS proteins may explain the polymorphic phenotypes of HE/SREAT. Only when elevated amounts of these Ab are synthesized and trespass the blood-brain barrier, HE/SREAT appears. This might explain why HE/SREAT is so relatively rare.
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